Sunday, April 28, 2013

Loskop Hop Sa Sa 2013

2013 LOSKOP
HOP SA SA Pre-ENTRY FORM

RIDER DETAILS

NAME
& SURNAME

CONTACT
DETAILS

EMAIL
ADRESS

NAME
OF CLUB

AREA
OF RESIDENCE

INDEMNITY I ,
_________________________________ acknowledge that RIVERSIDE LODGE is a RIGHT
OF ADMISSION RESERVED PREMISES and I agree to adhere to the rules of the
organisers , as well as the owner of the property. I further agree to
participate in the 2013 LOSKOP HOP SA SA
Rally entirely at own risk and do hereby indemnify the organisers and
the owners of the venue and their agents
any claim what so ever, which may arise from my participation in the
said event. Firearms are strictly prohibited

Signature: ___________________________

NOTE: The pre entry R160 and proof of payment must
reach us before 28 June 2013